“At best we are brave storytellers. At worst, we become Machiavellian” (Houseman)

Coming from a research background (many years ago I was the student representative on the University of Sheffield Research Ethics Board), I have a strong sense of ethics, and interacting with patients in a way that is approached with sensitivity and does not cause them harm.

Despite the discussion of emotive topics with patients who may often be vulnerable, filmmaking sits outside the purview of the ethics board.  Documentary filmmaking release forms are usually catchall and once some has signed off from a legal standpoint the filmmaking can use that footage in any way they see fit.  Either for a good, noble purpose, or to cause havoc with a sensational film if the filmmaker is cunning, deceitful, dishonest, or in other words, Machiavellian. 

My interest in film comes from a wish to do public good and to improve healthcare using patient story as the vehicle for this. 

While the testimony that interviewees provide is much longer than is ultimately included in the film, I want to portray them warmly and accurately and represent their truth through their story.

As there is no agreed ethical code of conduct for documentary filmmakers, it is up to each filmmaker (or filmmaking company) to navigate their way.  While very familiar with ethical requirements for research, I decided that I needed to explore this topic more from a filmmaking stance as part of my Master’s.  As part of this, I read a fabulous book, Adventures in the Lives of Others: Ethical Dilemmas in Filmmaking , which remains one of my favourite books to this day.  It is a compendium of essays written by filmmakers and producers on their ethical standpoint in filmmaking. Not only do filmmakers have “different values and ethical standards, and different ways of seeing things” (Broomfield)  but each filmmaking is different and therefore necessitate a different decision to be made as each filmmaker feels appropriate.

I feel that my filmmaking style and ethical outlook is in line with that of Maguire who believes that it his responsibility to portray his “characters as fairly and as kindly as possible.”  He goes on to say that “I have a duty of care towards them, and I would not put something out there which I feel would be damaging”. This is very much my ethos. I am upfront in the aims of project and explain where the films will be used.  I offer participants the opportunity to review and comment on rough cuts and remove anything that they are not comfortable with. I try to make sure that I represent them authentically.  

Beyond the impact of final finished product, there are other aspects of ethics to be considered.  First, as I am introducing myself and my camera into the lives of patients and family members, I need to consider my justification for doing so.

“with all good filmmaking, the two most important decisions you make are working out what you’re going to point the camera at, and why it is there in the first place – why it’s ok to intrude into the personal and professional lives of others” (Ford)

My justification is based on the vision that it will do public good by being part of the process that opens dialogue about health services.   This is in line with Dovey whose justification of their filmmaking is to “help make the world better”. My other justification is that the people involved are willing participants.  Obviously, in research coercion is not acceptable and the same should be true here.  Bourne notes that people either participate as they have something they want to say or “because I managed to persuade them it would be a good idea to take part and be given a voice”.  Reading this statement made me feel spectacularly uncomfortable, and I know that, certainly working with patients or other vulnerable people that I would never encourage someone to participate who was not willing.

Access to Patients

I always request that the key collaborator makes an initial introduction to the patients and family members who they think would be good participants in the film.  I then take time to explain what it will involve and where the film will be used.  Sometimes, in the course of this process, it become apparent that the person agreed to be in the film because their care provider asked them to, but they have reservations.  I make it clear that the decision to participate is completely up to them and sometimes there is palpable relief when they realise that they don’t have to. Obviously, this is not to say that the care provider had acted any way inappropriately, just that the patient felt a sense of duty towards them.  Having a stranger (i.e. me) say “it’s ok if you don’t want to do it” removes that sense of responsibility.  I do this both from an ethical standpoint but also the knowledge that if people are reserved then they are unlikely to make good film participants where an open, honest, and often vulnerable conversation on camera is required.

During Filming

The actual filming process can be quite emotional.  Many people find it cathartic to have an opportunity to talk about their experiences, but I am conscious of not causing too much distress.  This is a super tricky balance.  On the one hand, showing emotion in screen, revealing intimate details about themselves, etc, is at the basis of what makes a good story which is obviously what we are trying to achieve. On the other hand, I do not wish any harm to the interviewee.  Rabiger states, “don’t catch them when they fall” as offering comfort changes the relationship between the interviewer and interviewee. For me, there is value in remaining quiet after the interviewee pauses. This often results in further thoughts being shared which are often more poignant and with a raw honesty then the interviewee’s initial answer.  But ultimately, I agree with Steel whose standpoint is ‘human beings first and filmmakers second”.  I may remain quiet in the moment to fully allow the interviewee an opportunity to fully express their thoughts, but once that moment has passed, I will check that they are ok, inquire whether they want to stop, to take a break in filming, get a glass of water, etc. Graham discusses the quandary of when to stop filming, acknowledging that “there is no hard and fast rule” and therefore it is a balance between getting the emotions which are part of the narrative and not letting people get too much in distress.

Editing

The final place where filmmakers may become Machiavellian is how the film is edited and framed.  For each film I create, I may have an hour to an hour and half of interview footage with an individual but only a few minutes makes it into the film.  My storytelling and editing is guided by the pre-production research with a variety of stakeholders, but even so, there are innumerable ways that I could choose to order the spoken words.  I am committed to honouring the patient’s/family member’s voice, and this is reflected in my process of editing, where I check that I have accurately and warmly represented them, and that I have not included anything that they don’t like.

So where do ethics come into my process?

The discussion above highlights some of my thoughts and considerations to ensure that I engage in ethical processing.  Here is a summary of what this means in practical terms for the filmmaking process:

• Asking the commissioning collaborator to make initial contact with potential film participants and requesting permission to pass on their contact details to me.

• Providing an overview of the process of filming, their time commitment and where the content will be used to potential participants (similar to a research informed consent process) and clearly stating that it is entirely their decision whether they wish to participate.

• Requesting that film participants sign a release form but with the assurance that content will not be finalised until they have had an opportunity to provide feedback and let me know anything that they are not comfortable with which has been included in an edit.

• During filming, reassurance that they don’t have to answer any questions that they are not comfortable with

• During filming, offering to halt the filming or have a break if I have concerns that they are distressed.

• Working collaboratively with the participant in editing to check that I have accurately represented their voice and story.

• Offering the participant the opportunity to provide feedback at different stages of the editing process to remove anything that they don’t like or don’t think accurately represents them.